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Successfully adapting Stephen King is often a matter of knowing what to cut. It’s rare — perhaps unheard of — that the world’s most celebrated horror novelist gives a filmmaker too little to work with on the page. From the string of Universal Monster killings in Itto, well, pretty much everything in the original adaptation of The Shining, so many King films work because the screenwriters are judicious about what to keep, what to scrap, and what to consolidate.

Given the premise of Gerald’s Game, screenwriters Jeff Howard and Mike Flanagan (who also directs) had a lot more room to expand if they wanted to when compared to the typical King novel. At a (relatively) slim 332 pages, the book takes place almost entirely in one setting: a lake-house bedroom where Jesse (Carla Gugino) is handcuffed to a bedpost. Her husband, Gerald (Bruce Greenwood), lies dead on the floor after a sex game gone horribly wrong.

Because of the simple location, small cast size, and short timeframe, the entire novel comes off like a bizarre chamber drama. The Tommyknockers this is not. As such, it poses a different set of challenges than usual to the filmmakers. Instead of figuring out how to portray some elaborate monster with a minimal budget (i.e. “How do we animate hedge animals?”), the questions focus more on story structure (i.e., “How do we stay in one room with one woman and make it interesting?”).

As a director, Flanagan pulls off the narrative challenge by never forgetting that, for all its psychology, Gerald’s Game is still a visceral horror movie. So he wisely captures all of the outside forces tormenting Jesse — a hungry stray dog, a stranger in the house, her confinement and failed escape attempts — in gory detail. The terror of these elements comes from bluntness, rather than surrealism. The dog, for instance, simply strolls in and out of the bedroom, clicking its claws and making wet noises as it nonchalantly chows down on the dead Gerald’s arm. There’s no CGI leaping; no glowing eyes or overlong fangs.

The point of these tangible, more traditional horror movie elements (the wild animal, the serial killer, the tied-up protagonist) is that they reflect the more intangible demons inside Jesse’s head. Gerald’s Game is, by and large, a story about the shit women have to put up with when it comes to power dynamics involving men, whether in a job, marriage, father-daughter relationship, or anything involving sex. Gerald’s death is the result of Jesse protesting his bondage game — first growing uncomfortable with the handcuffs, then having to fight back against her husband when she realizes he’s actually trying to act out a rape fantasy. Their fight leads to a heated discussion about divorce, which leads to Gerald’s heart attack and him cracking open his head.

Once Jesse is on her own, her brain forces her to examine her marriage and personal history while also trying to escape. That’s when Flanagan inverts his directing tactics. Where the external horror is portrayed with grisliness, the psychological horror is fittingly more abstract. Because Jesse is actively trying to remember her past with Gerald and how it reflects abuse from her childhood, there’s a dreamlike quality to the flashbacks and hallucinations. Audio fades in and out, and Flanagan casts a critical, slow-burn eclipse sequence in hellfire red as the moon blocks out the sun. It feels surreal and intangible to the audience because it’s also surreal and intangible to Jesse, at least at first. It helps that Gugino and newcomer Chiara Aurelia — who plays Jesse as a little girl — lock into the script’s sense of escalation, conveying uneasy affection toward the men in their lives, then letting it unspool into guttural terror without the viewer even noticing. The long-running self-denial is just as important as the eventual catharsis.

Strangely, it’s when Jesse starts to articulate how her past connects to her present that the film starts to buckle under its own thematic weight. It’s tricky. On one hand, the unearthing of skeletons is essential to Jesse’s journey, the lynchpin to her confronting her fears head-on and breaking free of both her metaphorical and literal chains. But the self-examination comes out in a brain dump that stems from both a fidelity to the source material and a new device added by Flanagan and Macy. At a talkback after the film’s premiere at Austin’s Fantastic Fest, Flanagan revealed that he was stuck for a long time on how to put forth Jesse’s psychology lesson in a way that was captivating, instead of dry. His “aha” moment came with keeping Gerald more alive than he is in the book.

On the page, once Gerald is dead, the reader never hears from him again. But in the film, Jesse’s imagination reanimates him, creating a specter that also interacts with a phantom version of herself. Too often, Jesse 2 and Gerald 2 come off as a duo of wisecracking ghosts, alternating between taunting the real Jesse and ham-fistedly explaining her internal psyche, as well as the film’s various metaphors. At one point, they even vocalize how the men in her life are hungry dogs, just like the dog in the room. The symbolism is already obvious without a pseudo-Freudian gimmick to drive it home. The second piece of overly expository writing comes almost word for word from the book’s coda. The fact that it’s delivered in voiceover only adds to the clunkiness, recalling the end of Platoon by explaining an idea that the audience had probably already figured out themselves.

To Flanagan’s credit, though, Gerald’s Game was never going to be the easiest Stephen King novel to bring to the big screen, and despite a handful of faults, it’s that rare horror film that works on both a psychological and a visceral level. That’s where so many other filmmakers to take on the Master of Horror have fallen short. And with the King Renaissance that’s already underway — and several King Easter eggs hidden in Gerald’s Game (yes, even that big one) — there will hopefully be plenty of more opportunities for Flanagan to show others how it’s done.